“Reframing First Breaks and Early Crisis: A Capabilities-Informed Approach” — Kim Hopper

This paper will attempt to lay out a usable version of the capabilities approach and explore how its conceptual toolkit might aid us in thinking about “first breaks” and early crises. As will quickly be evident, this is very provisional work. Applied work in capabilities that deals with physical and mental states of distinction, limitation and exclusion – difference, “impairment,” and “disability” – is still in its formative stages and has yet to get its linguistic house in order. So, a forewarning: In making the argument, this paper will necessarily raid and pillage a number of literatures for concepts, distinctions and applications that will then be put to provisional use, found wanting or misleading, and revised accordingly or thrown out. Initial or trial adoption of terms should not be mistaken for final endorsement – and, indeed, one of this paper’s major points will be the need to interrogate the conceptual frameworks we routinely take for granted in discussing public mental health, to question our well-worn equipment of everyday thinking

To date, some preliminary efforts have been made to use the capabilities approach to rethink recovery and social integration as “outcomes,” to support self-determination, and to make a case for peer participation in research.1 Fueled by pilot funding from the Center to Study Recovery in Social Contexts, additional work is under way to examine decision-making, citizenship, parenting, community participation, complex poverty, and user views of freedom. This joint project with INTAR on “first breaks” opens fresh ground the charge is twofold: re-think and re-ground, framework and fieldwork – theory to direct the inquiry, practice that will need to be interpreted as evidence.

Prologue:
Transcript excerpt, BBC “Yesteryear” 2030
BBC Interviewer: “So, let me see if I have this right. You’re telling us that the practice of removing persons in distress from familiar surrounds and keeping them locked up, often in restraints and under heavy medication, watched closely – a reinvention of the medieval practice of quarantine, really – was actually commonplace 3 decades ago?”

Emer. Professor Psychiatry: “I would say so, yes.”

BBC: “The whole thing? The organized conspiracy to admit to hospital, the casual resort to restraints, the routine use of medications, and the non-negotiated, no-appeal, medically sanctioned nature of the process?

EPP: “It was what we knew, how we had been taught.”

BBC: “But even then – I was just reading an old (2009) Lancet – there were calls for actually listening to the patient and providing (I’m quoting now) ‘companionship, respect, practical support, and gainful activity.’ What about that?”

EPP: “I can only report that such activities were not part of the evidence base.”